海角大神

Episode transcript

Yvonne Zipp: 鈥淲hen it comes to drug addiction, the question becomes: 鈥榃hat is compassion?鈥欌�� 

That was a 20-year police veteran and president of the Portland Police Association talking to Monitor reporter Stephen Humphries and staff photographer Alfredo Sosa about a new pilot program there.  

After a spike in addiction and homelessness followed Oregon鈥檚 decision to decriminalize drugs, people who originally saw themselves on opposite sides of a tough issue teamed up to pioneer a new way to help those struggling to overcome addiction. 

That question 鈥� what is compassion? 鈥� lies at the heart of this Monitor series.

Staff reporter Sara Miller Llana and staff photographer Melanie Stetson Freeman traveled to British Columbia, Canada. There, mothers who have lost children to toxic overdoses believe that the government needs to offer a safer supply of drugs. These mothers have a simple reason for what many see as a radical request: 鈥淥ur children would not be dead,鈥� Jessica Michelofsky, who lost her son, Aubrey, two years ago, told Sara. 鈥淭hey might still be addicted to meth or cocaine, but they wouldn鈥檛 be dead.鈥�

Finally, special correspondent Dominique Soguel journeyed to Lisbon, Portugal. That country has become a world leader in battling drug addiction. Dominique takes an up-close look at how Portugal has successfully cut the number of hard-drug users in half since it decriminalized drugs in 2001. That 50% decrease came even as drug use spiked globally in the 21st century.

Our series also offers a window into the work of drug treatment providers. When those addicted to drugs feel alone and unworthy, providers respond with a different message.

鈥淎t its core is 鈥業 love you, even if you use drugs,鈥欌�� Tera Hurst, executive director of the Health Justice Recovery Alliance in Oregon, told Stephen. 鈥淭here is this unconditional love for the person. They see the person as a person and not as a sum of their very worst moments.鈥�

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[What follows are the edited versions of the stories that each writer reads in this episode. 鈥� Editors]

Stephen Humphries: Tera Hurst and Aaron Schmautz found themselves sitting side by side in a van zipping through Portugal. Close quarters. They鈥檇 long been accustomed to sitting on opposite sides of Oregon鈥檚 State Legislature, battling over drug policy. Would the two longtime adversaries spend the drive exchanging polite pleasantries about the Iberian Peninsula scenery?

Ms. Hurst is the executive director of the Health Justice Recovery Alliance, which represents over 100 addiction recovery groups. Her organization opposes incarceration for drug use. It鈥檚 a cause that鈥檚 deeply personal to her. As a teenager, she was diagnosed with alcoholism.

鈥淢y mom got to a place where she didn鈥檛 think I would live past 20, and I didn鈥檛 want to,鈥� she recalls. One night, at 3 a.m., she was contemplating suicide. At that lowest of moments, she entered rehab. 鈥淚 actually had a friend drive me around for four hours waiting with me, because I knew if I went to sleep, I wouldn鈥檛 go. I wouldn鈥檛 go, and I probably wouldn鈥檛 have survived,鈥� she recalls.

Mr. Schmautz is president of the Portland Police Association. He doesn鈥檛 want to incarcerate drug users, but he believes public drug use should qualify as a misdemeanor. 鈥淲hen you talk to a lot of people who are suffering from addiction, many of them will tell you that their pathway to sobriety was through the justice system,鈥� he says.

During his 20 years on the job, the second-generation police officer has seen it all. He recounts seeing a man bathing himself in the contents of a port-a-potty that the city provided for homeless people. 

鈥淭he question becomes, what is compassion for him?鈥� Mr. Schmautz asks. Do you just let him carry on? 鈥淥r is it compassionate to take away his freedom and put him in a place where he can actually get help? And honestly, like this is where the conversations are hard.鈥�

Ms. Hurst and Mr. Schmautz previously clashed over the voter-approved passage of Measure 110, which effectively decriminalized drugs for three years. This year, following a wave of public discontent, the Legislature rolled back decriminalization.

Last November, Ms. Hurst and Mr. Schmautz were among 24 Oregonian lawmakers, treatment specialists, and police on a fact-finding mission to Portugal. Ms. Hurst鈥檚 organization financed the trip to observe the European nation鈥檚 20-year-old drug decriminalization program. Oregon, like so many other parts of North America and the rest of the world, is trying to figure out how to lower deaths from drug addiction.

Inside the confines of the van, Ms. Hurst and Mr. Schmautz did something they hadn鈥檛 really done much of before. They started talking and listening to each other.

The pilot program that resulted from that trip offers promise for a new path forward, one in which both sides are working together. Treatment providers are teaming up with law enforcement to patrol high drug-use areas in Portland. When police intercept drug users in dire situations, rehabilitation specialists are on scene to offer a lifeline. The two groups have long disagreed over the most effective way to get people into treatment. Stick, meet carrot.

What made the two sides open to change? Answer: Oregon鈥檚 drug policy hit rock-bottom. In 2020, voters approved Measure 110. Voters turned against that experiment because crime remained high. Tent encampments proliferated. According to a new Centers for Disease Control and Prevention report, drug deaths in Oregon spiked by 27% last year. The Pacific Northwest bucked an otherwise encouraging trend: the first nationwide decline in fatal overdoses in five years.

In April, the state recriminalized low-level drug possession. 

Policy solutions to Oregon鈥檚 overlapping homelessness and drug addiction crises require rigorous debate. Here鈥檚 what Oregon is discovering about overcoming mistrust between various stakeholders. First, in-person relationship building is essential. Second, when two sides have to solve a problem they each care about, a desire for cooperation can override old feelings of competition. Third, find a common point of agreement as a grit of sand to make the pearl.

鈥淎lthough there was real disagreement about what to do, there was agreement, for the most part, on the human worth of people who have this problem,鈥� says Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University and author of 鈥淎ddiction: A Very Short Introduction.鈥� 鈥淪o people were fighting, but they were all fighting for the same thing. They were all upset about overdoses. ... The idea of recovery is, I think, a unifying concept.鈥�

It took 12 arrests for Joe Bazeghi to finally surrender. The man with a heroin addiction was dying. He鈥檇 already spent three months in intensive care. Then his girlfriend died of an overdose. One of the cops who responded to that call recognized Mr. Bazeghi. They鈥檇 gone to high school together.

鈥淗e said, 鈥楯oe, I鈥檓 not going to let you go this time,鈥欌�� Mr. Bazeghi recalls. 鈥淚鈥檓 gonna do everything I can to hold you.鈥�

The police officer helped him enter a program to get help. For Mr. Bazeghi, it was a relief. 

鈥淚 was treatment-ready long before I had access to treatment,鈥� says Mr. Bazeghi, now director of engagement at Recovery Works Northwest, a drug rehabilitation program. 鈥淢y case was desperate and I knew it. And, therefore, I was willing to accept treatment.鈥� 

Today, Mr. Bazeghi is one of the co-founders of Portland鈥檚 pilot program.

 In Portugal, Mr. Bazeghi also spent time with Mr. Schmautz, whom he describes as a 鈥済reat guy.鈥� He recalls a pivotal conversation. Mr. Bazeghi, a representative from Portugal鈥檚 national institute on drug use, a leader from the Mental Health & Addiction Association of Oregon, and Mr. Schmautz all liked Portugal鈥檚 street-team partnerships between police and outreach workers.

 鈥淲e said, 鈥楬ey, instead of waiting around, why don鈥檛 we pilot getting together?鈥欌�� says Mr. Bazeghi. 鈥淲e didn鈥檛 wait for a legislature or a mayor鈥檚 office or anybody to sign off on it.鈥�

The following month, a police bike squad and treatment providers quietly began working together in the Old Town neighborhood. In April, the successful program was officially expanded to other areas with $683,000 in funding.

Which isn鈥檛 to say there isn鈥檛 still lingering wariness. Just ask Ms. Hurst and Mr. Schmautz.

鈥淲hat was important with going on that trip with Aaron, for me, was really understanding that his perspective comes from his job,鈥� says Ms. Hurst, who gained an appreciation for the pressure the police are under to keep a community safe. 

In turn, Ms. Hurst shared her perspective that not all drug dealers are predators. Some are trying to feed themselves and, sometimes, a family.

A major fault line is over the most effective way to get people into treatment. Mr. Schmautz favors a tough-love approach; Ms. Hurst, a softer harm reduction that emphasizes creating a safe, humane environment for drug users. They can鈥檛 be forced into rehab. They have to be ready for it.

One point of agreement: Oregon can鈥檛 arrest its way out of its crisis. It鈥檚 a mental health and public health issue and should be handled as such. That鈥檚 the Portuguese approach. Oregon is still playing catch-up. Everyone agrees there鈥檚 a chronic shortage of beds and detox facilities. That鈥檚 why the provision in Measure 110 to fund shelter and drug treatment has been preserved. 

The wealth of funding 鈥� $211 million in 2024 鈥� has facilitated cooperation among nonprofits that previously saw themselves in competition.

鈥淢easure 110 said, 鈥業f you want to take one cent from this money, you must coordinate across a system of partnerships that will make up the entire continuum,鈥欌�� says Mr. Bazeghi, sitting in Recovery Works Northwest offices, yards from a suburban house that鈥檚 been converted into a detox center. 鈥淚n order for us to make money here, we have to work with residential treatment providers, housing providers, support and employment providers.鈥�

The same goes for working with law enforcement.

Yet according to Mr. Schmautz, there are still some in the treatment ecosystem who won鈥檛 partner with members of law enforcement because they say they鈥檒l lose credibility with people on the streets. 

鈥淟aw enforcement in our country has more touch points with people suffering from addiction than anybody else,鈥� continues Mr. Schmautz. 鈥淲hy would you not then want to be a partner with law enforcement to get people out of that justice system as soon as humanly possible, to give them hope, to give them a different pathway, if you truly care?鈥�

For treatment providers, suspicion of police is rooted in the war on drugs. For decades, it鈥檚 resulted in high levels of incarceration 鈥� especially among Black people and Latinos. 

鈥淭he actual culture of law enforcement is problematic because it is built in a kind of fear, militaristic 鈥榩ower over鈥� model,鈥� says Ms. Hurst. 鈥淭hey haven鈥檛 built that trust.鈥� 

Those misgivings have been underscored by police brutality in the national news, from children being killed in home raids using deadly force to the murder of George Floyd, which sparked a 鈥渄efund the police鈥� movement.

Mr. Schmautz remembers that backlash in 2020 vividly. He recalls the more than 100 days of rioting in downtown Portland.

鈥淎 mob of people broke into an occupied jail and lit it on fire,鈥� he says. 鈥淲ith people in it.鈥� 

Demoralized police officers quit in droves. 

鈥淏eing a police officer is becoming sort of a shameful activity for families that are left-wing or centrist. And so police are [self-]selecting more conservative,鈥� says Stanford University鈥檚 Mr. Humphreys, who helped guide drug policy for Presidents George H.W. Bush and Barack Obama. 鈥淚f that continues, this gets a lot harder because, for health and public health and public safety to work together, they have to at least agree on some shared reality.鈥� 

In an interview at her home, Ms. Hurst pushes back on the claim from some legislators that treatment providers aren鈥檛 willing to work with police. She says that if the police feel that way, law enforcement should invite treatment providers to morning roll calls at police stations to dispel their fears and preconceived notions.

鈥淎aron and I both know that that takes time and that takes buy-in, and he and I can only do so much,鈥� she says.

Mr. Schmautz has tried to model a path. He recalls inviting several treatment providers, who themselves had battled addictions, to the police station for a meeting about the pilot program. They were initially reluctant. Some had arrests and convictions, and they had bad memories of the place. But when the providers showed up, he ushered them into a meeting room that鈥檚 off-limits to the public. 

 鈥淭hat鈥檚 the level of access for people who historically haven鈥檛 had it,鈥� says Mr. Schmautz. 鈥淲hen you鈥檙e an addict, you feel like you鈥檙e just cast out. ... They were emotional. I鈥檓 like, 鈥榃e鈥檙e going to do this together. I鈥檓 not better than you. I鈥檓 just a guy doing a job, and you鈥檙e a guy doing a job. Let鈥檚 do it together.鈥欌��

That mutual recognition is already happening at a one-on-one level in the pilot program. Some treatment providers who were formerly incarcerated and living on the streets are now on patrols with law enforcement. When an officer comes across someone asking for help and then does what Ms. Hurst calls 鈥渁 warm hand-off鈥� to a treatment provider, they can witness firsthand what addiction treatment looks like.

At a leadership level, Ms. Hurst wishes that lawmakers would use their bully pulpit to convene constituents for more of the sorts of conversations that took place in Portugal. But she concedes that relationship building can鈥檛 all be incumbent on waiting for the other side to act. 

鈥淎aron and I probably need to get back to talking again,鈥� she says. She鈥檚 appreciative that he was willing to go to Portugal and engage in dialogue despite the pushback he received. 鈥淲e鈥檙e not out there usually advocating for the police. We鈥檙e advocating for thoughtful, effective strategies. Police have to play a role in this.鈥�

It may be difficult for the two sides to resolve fundamental philosophical disagreements. But the Justice Health Alliance鈥檚 website approvingly quotes something that Mr. Schmautz told the statehouse: 鈥淎ddiction and mental health concerns are a health issue. We cannot and should not attempt to arrest our way out of these issues.鈥�

Mr. Schmautz says that the only way forward is cooperation. Ms. Hurst and Mr. Bazeghi both agree. They still share the common goal of reaching people when they鈥檙e at their lowest moment and ready to accept help. 

During the winter months of the pilot program, Mr. Bazeghi recalls working alongside officers who鈥檇 found a fentanyl user freezing to death in a sleeping bag. The man had a realization: 鈥淚 don鈥檛 want to do this anymore.鈥� That night, he entered a rehab facility.

鈥淚f we can make people not feel separated, not feel exiled, feel safe ... then eventually that window is going to present [itself],鈥� says Mr. Bazeghi. 鈥淢easure 110 made us work together. We still have a ways to go there. It鈥檚 gotten so much better than in 2021 when we started this off.鈥�

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Sara Miller Llana: Jessica Michalofsky set off across rural British Columbia with one goal in mind: to pick up her son to take him back to the city of Victoria. Aubrey was struggling with addiction, and she wanted him home where she could try to keep him safe.

She arrived that night in the town of Nelson, pulling into a parking lot to figure out her next move. 鈥淚 just wanted to get him into the car,鈥� she says. And then her phone rang. Aubrey had died that day of an overdose.

Five years earlier, Ms. Michalofsky had been so relieved to get him in the car to Nelson, where he was born amid the snowcapped peaks and pristine lakes of the Kootenays. There, she thought, he could go to college and live with his father 鈥� far away from the easy drugs he started using as a teen. 鈥淚 was terrified he was going to die,鈥� she says.

At first, it seemed to work. He enrolled at Selkirk College, and graduated with awards.

But drugs were just as available, if not as visible, in rural British Columbia. With its vast distances and dearth of services, each mile away from methadone programs, doctor prescriptions, drug testing, and overdose prevention sites makes life for rural drug users more precarious.

Aubrey Michalofsky died Aug. 30, 2022, at age 25. He had fentanyl in his system. He is one of over 14,000 residents to have fatally overdosed since 2016, when the Canadian province declared a public health emergency amid a toxic supply of synthetic opioids. Last year, British Columbia whipped drug politics into a frenzy by making it legal to possess and consume small amounts of cocaine or heroin. Since Aubrey鈥檚 death, his mother has joined a growing chorus of advocates calling on the government to go even further. These mothers want the province to offer something many regard as unthinkable: a safe and regulated supply of drugs.

Critics, from politicians to the public, argue that supplying drugs makes them even more entrenched in the fabric of society, while taking resources from recovery and treatment. But for mothers like Ms. Michalofsky 鈥� the ones who arguably hate drugs more than anyone ever could 鈥� it鈥檚 the only compassionate way forward.

鈥淣one of us started out thinking, 鈥極h, yeah, let鈥檚 get my kids some drugs.鈥� Nobody wants their kids to do drugs,鈥� she says. 鈥淚f I could wave a magic wand and get rid of all drugs, great.鈥�

But in 2023, British Columbia registered a record 2,558 suspected overdoses, the vast majority from poisoning.

鈥淲e have to think outside the box,鈥� says Cheryl Dowden, executive director of ANKORS, a harm reduction organization in downtown Nelson, a historic silver-rush town of roughly 10,000 people. 鈥淭he toxic drug crisis is a humanitarian crisis of epic proportions, and it鈥檚 not being treated that way.鈥�

Compared with most other places, British Columbia has already thought outside the box.

In January 2023, the western province became the first in Canada to decriminalize the possession of small amounts of hard drugs. It was the second jurisdiction in North America to do so after Oregon. As in Oregon, the pilot program met public backlash, intensified by local and national politics. In May, the province asked the federal government to roll back the program, making it illegal again to consume drugs in public.

Drug policy has become a political lightning rod. The Conservative rival to Prime Minister Justin Trudeau has appealed to Canadian 鈥渃ommon sense.鈥� In May, Pierre Poilievre asked if British Columbians were with him on a different approach 鈥渢hat would ban the drugs, stop giving out tax-funded opioids, and instead invest in treatment and recovery to bring our loved ones home drug-free.鈥�

Decriminalization, at its heart, was intended to destigmatize drug use and remove police from the equation of how best to help users. But in places like Nelson, it had the reverse effect. Nelson Police Chief Donovan Fisher talks about reams of letters his department received from community members angered that the police spent the year not doing anything about the drug use they were seeing in broad daylight, from City Hall to Main Street. Nelson Mayor Janice Morrison likened it to 鈥渃ompassion fatigue.鈥�

When a safe inhalation site was proposed on the outskirts of downtown, a neighborhood group opposed it, wearied by an increase of drug use and disturbance near their homes. 鈥淎 lot of parents are saying, 鈥榃e don鈥檛 want to shelter our kids,鈥欌�� says resident Kirsten Stolee, who has two teenage daughters, 鈥渂ut I don鈥檛 think kids should see what my kids have seen in the last year.鈥�

Amber Streuckens was devastated when the inhalation site was canceled. While she is on the front lines of the crisis as an educator with the Rural Empowered Drug User Network, she understands the public response. 鈥淲e鈥檙e seeing people die in our communities. We鈥檙e seeing people who are very destabilized by a toxic drug supply. ... There鈥檚 been no magic bullet, right? So I think public discontent is reasonable,鈥� she says. 鈥淏ut I also think that it鈥檚 being weaponized in a very intentional way.鈥�

It鈥檚 in this context that advocates for safe supply 鈥� the most controversial policy, but what advocates say is by far the most important 鈥� are trying to effect change. 鈥淥ur main goal right now is to stop the deaths,鈥� says Leslie McBain, who co-founded Moms Stop the Harm, a network of Canadian families who鈥檝e lost children to the drug crisis. 鈥淏ut this fight seems to be getting more and more difficult.鈥�

British Columbia has long pioneered drug policy. In 2003, Insite in Vancouver opened as the first legal, supervised safe consumption site in North America. The province has supported needle and syringe programs, methadone therapies, and expanded prescriptions of opioids and stimulants. The newest idea is the 鈥渃ompassion club鈥� model, in which activists buy, test, and sell safe drugs at no profit.

Harm reduction policies have historically come from the bottom up by drug user groups responding to needs in their community 鈥� and only later 鈥渟ociety comes around,鈥� says Tim Dickson, a Vancouver-based lawyer.

He is currently representing the Drug Users Liberation Front, which had applied for an exemption to Canada鈥檚 Controlled Drugs and Substances Act to run a compassion club. The request was rejected; the group continued operating anyway. Last year, amid backlash to decriminalization and questions around the 鈥渄iversion鈥� of safe supply 鈥� whether criminals are getting their hands on the drugs 鈥� it was arrested and shut down.

Even though doctors can prescribe opioids and stimulants, the British Columbia coroner鈥檚 office says only a fraction of drug users access the medical system: some 5,000 per month out of 225,000 users.

Mr. Dickson agrees not all Canadians are yet on board with the notion of a compassion club. 鈥淏ut that doesn鈥檛 undercut whether it鈥檚 right and just and fair or not,鈥� he says.

Many opponents fear a proliferation of drugs. The United Nations Office on Drugs and Crime鈥檚 World Drug Report 2024 notes that drug use has risen to 292 million users, a 20% increase in a decade. It also notes that in jurisdictions where cannabis has been legalized, drug use appears to have increased.

DJ Larkin, executive director of the Canadian Drug Policy Coalition, says that nonmedical safe supply differs from the selling of cannabis because it wouldn鈥檛 be for profit. 鈥淲e鈥檙e looking at this through the lens not of trying to sell people something,鈥� they say, 鈥渂ut rather, if someone accesses it, how do we make sure it鈥檚 as least dangerous as possible?鈥�

The British Columbia coroner鈥檚 office recently advocated expanding nonmedical supplies of drugs. While police Chief Donovan in Nelson grapples with some aspects of decriminalization, he鈥檚 come to see safe supply as the 鈥渓esser of two evils.鈥�

Recovered drug user Guy Felicella says many people in the recovery community only support expanded treatment 鈥� not the provision of more drugs. But, he says, many forget that recovery is hardly ever linear.

鈥淚鈥檓 not hard-line on it because it took me 31 years and it takes most people ... multiple years to figure out how to stay sober,鈥� he says. 鈥淎nd when they relapse, that drug supply is sitting there waiting for them and kills them.鈥�

鈥淲e鈥檙e always saying, 鈥楪et your drugs checked. Get your toxic drugs checked; get your illegal drugs checked,鈥欌�� Mr. Felicella says. 鈥淭ell me what the difference is.鈥�

The national debate has had a silencing effect in parts of rural British Columbia. One founder of a compassion club in Nelson declined to be interviewed because of the threats they face. In Nelson, ANKORS operates a drug testing center and an overdose prevention site. It works with three doctors who prescribe drugs. But many users live scattered throughout the valley. Bus service is scant. Many don鈥檛 own cars, and getting to appointments takes resources and time. 鈥淭ransportation issues in rural communities are massive, and sometimes with pretty awful consequences,鈥� Ms. Dowden says.

Last year, 16 people died of overdoses in Nelson. That pales in comparison with Vancouver, where 650 died. But Ms. Streuckens offers devastating context. 鈥淢aybe our numbers don鈥檛 seem as huge ... but we know most of those 16 people,鈥� she says. 鈥淲e miss these people.鈥� 

Ms. Michalofsky is reflective about her son鈥檚 death. She knows he could have died with any drug encounter over the years he used. But he was doing his best in Nelson when he enrolled himself in a methadone program, excelling at Selkirk College, where she is raising funds for the Aubrey Michalofsky Social Justice Scholarship.

At the time of his death, he was working a job as dishwasher and helping to take care of his ill father. But it was too hard to get into town without a car or reliable transport, she believes. Aubrey eventually left the methadone program, which is when he began to spiral. His mother says she just knew he should be back in Victoria.

An avid athlete, she has put her focus on advocating for safe supply with Moms Stop the Harm. Last year she ran 900 kilometers (559 miles) from Nelson to Victoria, setting off from the park along the lake where Aubrey celebrated his birthdays growing up.

The year before, she ran hundreds of miles around the provincial Health Ministry building. As a result of her endurance, she secured a meeting with the province鈥檚 public health official, Bonnie Henry, pleading with her to offer a bus service across rural areas to hand out methadone. 鈥淣o,鈥� is what she heard.

鈥淲hy?鈥� she asked. 鈥淲hy? We did all this stuff during COVID. Why can鈥檛 we do this?鈥�

This spring, she got behind the wheel and traced the journey she made to the Kootenays to try to save her son 鈥� this time with a U-Haul.

Rural British Columbia has given her the opportunity to buy a farmhouse with a big garden for much less than in Victoria. It also gives her the chance to be close to where Aubrey last lived, and died.

But she鈥檒l fight for what rural life took away from her family, too 鈥� safe drugs for a child struggling with addiction. She is joining forces with Moms Stop the Harm advocates throughout the region.

鈥淢ost of the moms that I know, we have become advocates of safe supply only because we see that our children would not be dead. They might still be addicted to meth or cocaine, but they wouldn鈥檛 be dead,鈥� she says. 鈥淪ometimes I still can鈥檛 believe that it happened. It will be two years at the end of August. I still sometimes hope maybe it鈥檚 not true.鈥�

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Dominique Soguel: Nuno and Mariana are on a first-name basis with everyone in the grip of drug addiction they encounter while crisscrossing Lisbon. They know those who reside in tents on littered, suburban hillsides just as well as those who consume drugs in bustling neighborhoods at the heart of the Portuguese capital.

They know their stories 鈥� like that of the university professor-turned-police spotter for drug traffickers, or the migrant from India struggling to navigate health services. And, most importantly, they care about everybody鈥檚 immediate and future needs. 

鈥淥ur priority is to make relationships with people,鈥� says Mariana Gomes, a bubbly social worker who methodically jots down whom she meets and what they need in a giant binder. 鈥淲hen we say, 鈥楧o you need anything?鈥� we really are asking.

鈥淲e try to promote an honest relationship, a horizontal conversation,鈥� she continues. 鈥淚t seems small, but it makes all the difference in building trust.鈥�

The pair walk in thick-soled shoes while distributing silver foils and safer drug-use kits. Their eyes are trained to recognize health issues. They handle the basics on the spot and organize follow-ups for harder cases.

 鈥淢ost of the job we do is about creating goodwill, because we don鈥檛 have all that much to give,鈥� says Nuno Maneta, a peer educator who overcame drug addiction himself. 鈥淚t helps a lot if you understand the point of view of the person.鈥�

The mindset of this duo working for Crescer, a nongovernmental agency, reflects Portugal鈥檚 broader approach to debilitating drug use. The goal is to help people overcome the issues that drove them to that point. It can be mental or physical health issues, homelessness, or job loss. People are not judged for consuming drugs. Instead, they are gently guided to manage addictions in healthier ways.

鈥淭hey are lost on drugs, but in general these are good people,鈥� says Mr. Maneta, who sees the key to recovery as the right mix of personal will and consistent support. 鈥淲e don鈥檛 know if they are ready or not, but if they want to, we help them to try to take the right steps.鈥�

Portugal鈥檚 drug addiction landscape and approach to treatment was very different at the turn of the century. The country at the time faced a drugs crisis and the HIV/AIDS pandemic. Those with drug addictions who had lost a limb due to infections were a common sight in neighborhoods like Casal Ventoso, where thousands of people were consuming hard drugs like heroin.

鈥淭hese people were almost never in touch with social and health structures,鈥� says Americo Nave, head of Crescer, which was established in 2001. 鈥淭oday, it is very difficult to find someone who is not in touch.鈥�

Mr. Nave credits the change to the 2001 decision to decriminalize drug consumption in Portugal, and to a society-wide effort to pursue a harm reduction strategy instead. Legal reform was followed by outreach teams, homeless centers for drug users, low-threshold methadone programs, and walk-in points of care.

鈥淲e constructed a net, a whole system of complementary solutions,鈥� he says.

The NGO itself follows a multipronged approach, helping people restore their sense of dignity and faith in the future. Its programming includes housing solutions, on-the-job training, individual counseling, and help navigating appointments with medical and state entities. Crescer has 107 paid employees; a quarter of them hail from a vulnerable situation.

鈥淲hat made the difference is we worked together with these people, shoulder to shoulder,鈥� stresses Mr. Nave. 鈥淲e look at people based on their skills and not their bad deeds. And we work with these people to fight stigma 鈥� that鈥檚 the biggest problem.鈥�

Tiago Gomes is a man on the mend, determined to renounce cocaine and heroin. It鈥檚 been two months since the last use 鈥� a feat he credits to Crescer, which moved him off the streets into housing during the COVID-19 pandemic. Initially, he slept on the floor because he had to relearn the habits of being indoors. Now, he is focused on getting a job and reconnecting with his daughter.

鈥淚t鈥檚 a process,鈥� he says, sitting in a tiny studio that costs 鈧�700 ($760) per month. Participants in the municipality-funded housing-first program are expected to contribute toward rent, provided they manage to secure an income. 鈥淪ometimes I feel like I am missing drugs; sometimes I forget drugs. I know they exist, but I try to escape.鈥�

Drug consumption is not legal in Portugal. What the 2001 reform changed is that it is no longer a criminal offense. Possession for individual use may lead to administrative penalties, such as fines or community service. Local commissions 鈥� comprising legal, health, and social work professionals 鈥� decide whether such a penalty is applied.

鈥淚t鈥檚 more carrots [than sticks],鈥� says Jo茫o Goul茫o, the national drug coordinator who was one of the original architects of the law. 鈥淪omeone with addiction is always divided between the willingness to stop it and the willingness to continue to do it. So, if you are going to offer something to bring about a change, you need to offer it now.鈥�

The capacity for Portugal to do so has been limited by budget cuts. Still, about 80% of people presented to commissions today are recreational and occasional users rather than problematic ones. The commission considers risk factors 鈥� divorce, loss of job, a death in the family 鈥� when inviting people to access treatment.

Portugal offers a wide range of models for recovery. There are therapeutic communities focused on specific groups like youth, seniors, pregnant women, and women with children. In the case of opioids, people may benefit from substitute treatments based on methadone or buprenorphine, which help reduce withdrawal effects and cravings.

The results have won Portugal global attention. The Portuguese approach is credited with reversing the drug addiction explosions of the 1980s and 1990s and halting the HIV/AIDS pandemic. Across the Atlantic, it has inspired policymakers in British Columbia, Canada, and in Oregon. In Europe, the Czech Republic has decriminalized drugs, and Ireland is considering that step.

Decriminalization alone does not work, cautions Dr. Goul茫o. 鈥淭his is a very volatile area,鈥� he says. 鈥淥ne of the key elements in our case, for the good and the bad, is that we have been stable in terms of leadership, at least at the technical level. I have worked with different governments and what varies is the speed and attention given to this issue.鈥�

Information about the evolution of habits related to drug use is collected in an annual survey of 18-year-olds. Another source of insights are NGOs working on the front line. A third indicator is the number of people who approach treatment facilities. Recent crises ranging from the financial crisis to COVID-19 have partially undermined progress and made the problem more visible. So has the rise in homelessness and migrant communities struggling with addiction.

鈥淭here is a clear decrease,鈥� says Dr. Goul茫o, who says there were about 100,000 hard-drug users in the country in 2001. 鈥淲e estimate that we have half the problematic users that we had in the beginning of the century.鈥�

As dusk descends in Lisbon, the assistant cooks and servers of 脡 Um Restaurante spring into action. Some, like Daniela, are struggling with new-job jitters. It鈥檚 her second day of work. Rafael do Carmo, who took the cold-turkey approach to overcome methadone addiction, has been there for over six months.

鈥淓very day, they become a little bit more focused and hopefully ready for the real world,鈥� says chef Ricardo Guimar茫es of his team.

The restaurant delivers diners sophisticated dishes like duck and yellow croaker ceviche. As part of Crescer鈥檚 program, it offers staff an opportunity to start fresh and learn the basics of professional etiquette: Show up ready to work and on time. The chef copes with unannounced absences with grace and gentle explanations about why their presence matters.

鈥淭hese are normal people who need our help,鈥� says Jos茅 Agostinho, who oversees the restaurant project. 鈥淭hey are not aliens. We need to create tools for them to rebuild their lives. Otherwise, they have nothing.鈥�

[MUSIC]

Clay Collins: Thank you for listening. This three-story set was introduced here by Yvonne Zipp, the Monitor鈥檚 features editor. The stories were voiced by writers Stephen Humphries, Sara Miller Llana, and Dominique Soguel from Oregon, British Columbia, and Portugal, respectively. Produced by Mackenzie Farkus, with sound engineering by Alyssa Britton and original music by Noel Flatt, for 海角大神. Copyright 2024.